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临床分离多重耐药鲍曼不动杆菌对替加环素体外敏感性研究。

Investigation of in-vitro susceptibility of multidrug-resistant Acinetobacter baumannii strains isolated from clinical specimens to tigecycline.

机构信息

Department of Medical Microbiology, Abant Izzet Baysal University School of Medicine, Gölköy, 14280, Bolu, Turkey.

出版信息

Bosn J Basic Med Sci. 2013 Nov;13(4):266-70. doi: 10.17305/bjbms.2013.2338.

Abstract

The management of infections due to A. baumannii is difficult because of rapidly developing resistance, however, tigecycline, a glycylcycline antimicrobial, is in use for several years. In the present study, it was aimed to determine the susceptibility rates of A. baumannii to tigecycline. A total of 90 A. baumanni isolates were tested using three methods such as disk diffusion, broth microdilution, and E-test. The MIC50 and MIC90 values and the MIC range were found as 2 µg/ml, 4 µg/ml, and 0.1-8 µg/ml by microdilution; and 2 µg/ml, 6 µg/ml, and 0.1-12 µg/ml by E-test, respectively. There were a few major errors as well as the minor rates were all high as between 35.7%-46.7%. The accuracy rates between the methods were low as 53.3% (48/90) between disk diffusion and E-test, 51.1% (46/90) between disk diffusion and microdilution, and 60.0% (54/90) between E-test and microdilution. In the ROC curve analysis, an inhibition zone diameter of susceptibility breakpoint of 21.5 mm had sensitivity between 68.8%-88.9%; specificity between 81.9%-87.9%; and accuracy between 80.0%-83.33%. An analysis based on EUCAST's non-species breakpoints, the MIC tests showed higher accuracy with a rate of 96.7%, however, performance of disk diffusion got worse as lower than 25%. In conclusion, we showed that the reliability of the methods even did not remain as high as the past. Our study presented that none of three methods revealed reliable results in determination of susceptibility of A. baumanni to tigecycline, so the clinical response should be followed up carefully in such cases.

摘要

鲍曼不动杆菌感染的治疗较为困难,因为其耐药性迅速发展。然而,替加环素作为一种甘氨酰环素类抗菌药物,已应用多年。本研究旨在确定鲍曼不动杆菌对替加环素的药敏率。采用纸片扩散法、肉汤微量稀释法和 E 试验三种方法检测 90 株鲍曼不动杆菌。微量稀释法的 MIC50 和 MIC90 值及 MIC 范围分别为 2μg/ml、4μg/ml 和 0.1-8μg/ml;E 试验分别为 2μg/ml、6μg/ml 和 0.1-12μg/ml。存在少数重大误差,且次要误差率较高,均在 35.7%-46.7%之间。不同方法之间的准确性较低,纸片扩散法与 E 试验之间为 53.3%(48/90),纸片扩散法与微量稀释法之间为 51.1%(46/90),E 试验与微量稀释法之间为 60.0%(54/90)。在 ROC 曲线分析中,敏感性为 68.8%-88.9%,特异性为 81.9%-87.9%,准确性为 80.0%-83.33%的药敏折点为 21.5mm 的抑菌圈直径。基于 EUCAST 非种属折点的 MIC 试验显示,准确率为 96.7%,但药敏纸片法的性能较差,准确率低于 25%。总之,我们发现即使是过去的方法,其可靠性也没有保持很高的水平。我们的研究表明,三种方法均不能可靠地确定鲍曼不动杆菌对替加环素的药敏性,因此在这种情况下应密切关注临床反应。

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